Prevalence Of Gestational Diabetes Mellitus According To Iadpsg And Nice Criteria Editorial Comment

Hyperglycemia during pregnancy leads to a plethora of complications such as preeclampsia, cesarean delivery, and increased perinatal mortality as well as adverse neonatal health conditions including long-term obesity and diabetes. However, there is disagreement regarding the best approach to screening for gestational diabetes mellitus (GDM). The International Association of Diabetes and Pregnancy Study Groups (IADPSG) developed a classification for GDMdiagnosis. According to these criteria, one measurement of plasma glucose equal to or above 5.1 mmol/L when fasting, 10 mmol/L for 1-hour measurements, and 8.5 mmol/L for 2 hour measurements should be obtained for GDMto be diagnosed. According to the IADPSG criteria, overt diabetes in pregnancy is indicated with a 7 mmol/L FPG or random plasma glucose concentration of 11.1 mmol/L. Alternatively, the UK National Institute for Health and Care Excellence (NICE) proposed criteria for diagnosis of GDP with one fasting plasma glucose (FPG) measurement of at least 5.6 mmol/L or a 2-hour plasma glucose measurement of at least 7.8 mmol/L.This retrospective cohort study aimed to compare the impacts of the IADPSG and NICE criterium on the prevalence of GDMand overt diabetes as well as to investigate the prevalence of maternal and perinatal outcomes among pregnant women with an FPG of 5.1 to 5.5 mmol/L. Data were obtained from women with a singleton pregnancy who received a 2-hour 75-g oral glucose tolerance test (OGTT) at 24 to 32 weeks of gestation at the Clinical Hospital Center, Zagreb, Croatia between 2012 and 2014. Patients were separated into 5 groups based on IADPSG and NICE criteria using the OGTT results.Of the 4646 pregnant women included, 1074 (23.1%) and 826 (17.8%) had hyperglycemia in pregnancy (HIP) according to IADPSG and NICE criteria, respectively. A total of 409 pregnant women (8.8%) met the FPG criteria for HIP according to IADPSG, but not NICE. These women had an FPG level of 5.1 to 5.5 mmol/L and had a higher rate of large for gestational age (LGA) newborns (odds ratio, 3.7; 95% confidence interval, 2.0-4.6) and cesarean delivery (odds ratio, 1.8; 95% confidence interval, 1.3-2.3). Of the entire cohort, 50 pregnant women (1.1%) had overt diabetes, whereas 540 pregnant women (11.6%) had HIP according to both IADPSG and NICE criteria. Rates of gestational hypertension and preeclampsia were higher among those diagnosed with GDM according to either criterion than within the control group (P < 0.001).This study finds that, although 409 pregnant women among the cohort wouldn't have been diagnosed with GDMaccording to NICE criteria, there is an increased risk for LGA newborns and cesarean delivery associated with an FPG level of 5.1 to 5.5 mmol/L when compared with a control group. The results indicate that IADPSG criteria, rather than the NICE criteria, identifies additional women at increased risk of pregnancy complications associated with GDM.